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Re: Not getting enough

Hi there! We had a long struggle with tongue tie, getting it cut twice. First time i kept waiting, measuring intake, crying, waiting more. Second time it took a day and he had it figured out. The latch still took a LOT of work to get right, and he still fussed about prefering bottles for a while, but within a week we were really nursing. This is all to say: 1) make sure the cut was enough and dont be afraid to go back to the doc & 2) realize that even once it's possible, your baby still has to learn how to nurse. Let the baby suck as much as possible on mama. Sometimes it helps to get them sucking on your finger first, to remember how to do it, and then to latch them on. I would get help with the latch, too, from a lac. consultant if you can. Good work getting the frenulum cut! Some docs really resist doing it.
Also, & i cant stres this enough, no pacifiers until lo knows how to latch!

Kate

Mother to a sweet boy, born at 34 weeks on 2/11/11.
Proud that I grew 26 lbs of baby before solids, and still counting...

Re: Not getting enough

with previous post. Now, here is my novel:

helpingpapa, did you have any aftercare assistance after the frenulum clip? Has mom seen a Board Certified Lactation Consultant who has observed mom and baby while nursing and given her latch and positioning suggestions? Do you have a La Leche League Group near you? Have you contacted them?

When a bb has tongue tie, a frenulum clip is usually needed in order to make breastfeeding possible. But it’s not always a magic bullet that solves everything immediately. Baby has been trying to nurse all this time with this issue. He has possibly learned some not great habits. It may take some time for bb to learn to nurse effectively with the new tongue mobility. Also many bb's with tt also have a high palate, and that can make nursing difficult as well. It's not a barrier to breastfeeding by any means, but it can cause issues it would be really helpful to work with a board certified lactation consultant (IBCLC) on. Is nursing any more comfortable for mom? I assume she has/had issues with painful latch as well?

If weight gain and milk transfer are a concern, why not simply supplement more expressed milk while still nursing? Or are you saying that baby cannot take bottle well either (this can happen with tongue tie)? You don’t need to supplement with bottles. Supplementing can be done in a breastfeeding supportive way.

But there is no reason to stop nursing and measure every drop of intake. Sorry I have to really disagree with a previous poster on that. Pumping and exclusively bottle feeding this early on is a very good way to ensure one is never is able to breastfeed. Babies learn to breastfeed by breastfeeding, giving bb a bottle is not helping him learn. So, assuming mom wants/hopes to eventually exclusively breastfeed, (certainly still possible, you are most certainly not out of options, although you may feel tired and overwhelmed and it feels that way.) this should only be done if absolutely necessary. And its not, in this case. Despite the tt, baby is nursing and is getting at least some milk when he does. This is likely to improve as long as there is milk there, and you say supply is not a concern. Maybe baby does not transfer enough, but that would indicate a possible need to give some supplemental feedings, not switch from nursing to bottles only.

When supplementing ,it is helpful to do so in a breastfeeding supportive way. First, as much as possible, supplement with moms own expressed breastmilk. 2nd, consider an alternative to bottles. In terms of how much it affects breastfeeding, an at the breast supplementer (such as the Medela SNS or LactAid, you can home make one as well) would be a first choice, cup or spoon feeding the next choice, and paced bottle feeding a third choice. (Here you can find videos on using a lactation aid, cup feeding ,and, also of interest, one of a bb after frenulum clip with mom using breast compressions to help bb get more milk: http://nbci.ca/index.php?option=com_...id=6&Itemid=13
BTW these vids are available in several languages)

Here is a description of paced bottle feeding: http://www.llli.org/docs/00000000000...astfedbaby.pdf
Some combo would be OK too. The idea is to find the solution that supports breastfeeding the best but also that which everyone can live with.
At this age, output (poops) is a good indicator of intake and of course you can have the weight checked regularly (always using the same scale under same conditions-even if bb just had a big poop it can make a difference) So measuring intake with bottles is not really necessary in most circumstances, and certainly not with healthy, full term babies.

As long as baby is not nursing effectively, mom should pump, not only in order to give her expressed milk to bb but also to keep her supply in good shape.

The book The Womanly Art of Breastfeeding (8th edition-2010) is an excellent resource, it is based on research and scientific evidence and it gives all kind of great suggestions for any number of issues. It also has the best discussion of the issues around tongue tie I have ever seen, anywhere. It is available in several languages and retails for $20.00 US. You can find it for less online usually.

Re: Not getting enough

Last night he was only getting 20-35 ml per feeding. Today we ditched the nipple shield and he started taking between 60-75ml per feeding, with so far no ill effects to mom. We have still supplemented him a bit to try and get him up to 85ml recommended by lactation consultant, but hopefully we can get that down here in a bit. Mom has also had to pump a lot less as he appears to be getting almost all she has after about 5 minutes a side (really fast eater!!). So, we're a lot more happy today and hope he can keep the progress up and get some weight gain over the weekend!

Re: Not getting enough

Oh goodness, I missed that mom was using a nipple sheild. That can make a big difference sometimes. OK, so happy to hear things are going so much better!
As long as nursing is not painful for mom, she can feel free to let baby go to town. A baby cannot nurse too much. Now that things appear to be normalizing, here is a nice article about what is normal and expected in the early weeks. http://www.kellymom.com/bf/normal/newborn-nursing.html

Keep taking good care of mama and baby, papa. These intense early days will be a memory before you know it.

Re: Not getting enough

So glad to read your update! These initial weeks are tough but soooo worth it. And nursing at the breast is easiest long term, so I agree with supplementing in the most bf'ing friendly way too. We had to supplement my son initially for other reasons (just till he was 14 days old) and he did transfer from breast to bottle fine (I would nurse, supplement, pump) but he had no latch issue (it was my supply). Anyway, very awesome news. Just let him nurse nurse nurse and I think he'll get the hang of it

Mama to five beautiful kids- 9, 8, 3, 2 and currently nursing our new baby girl born 1/20/2013

"It should not be necessary to tell reasonably intelligent mammals to suckle and not dismember their neonates." ~Susan Blustein